Abstract

Background Although a number of previous studies have reported an association between maternal smoking during pregnancy (MSP) and externalising
behaviour problems among offspring, it has been suggested that this relationship is spurious due to the failure of these studies
to properly account for important confounding factors.

Methods The relationship between MSP and adult criminal offending was examined using data from 3766 members of the Providence, Rhode
Island, cohort of the Collaborative Perinatal Project. Information on MSP and most potential confounders was collected prospectively
throughout pregnancy. In 1999–2000 all offspring had reached 33 years of age and an adult criminal record check was performed.
Because previous research has been criticised for not properly accounting for confounding influences, our primary aim was
to determine whether the MSP–criminal offending relationship held after efficiently adjusting for a wide range of sociodemographic
and family background characteristics using propensity score methods.

Results The association between MSP and adult criminal offending remained after controlling for propensity scores. Offspring of mothers
who smoked heavily during pregnancy (≥20 cigarettes per day) had the greatest odds of an adult arrest record (OR 1.31, 95%
CI 1.06 to 1.62). Findings also suggest that MSP may be an independent risk factor for adult criminal histories marked by
multiple arrests. Lastly, our findings show that the impact of MSP operates similarly across both genders.

Conclusion Results from this study provide evidence of an association between heavy MSP and long-term criminal offending. Any causal
association is likely to be weak to moderate in strength.

Footnotes

Funding This work was supported by a National Research Service Award (grant number T32 MH17119) from the Harvard Training Program
in Psychiatric Epidemiology and Biostatistics; the Flight Attendant Medical Research Institute; grant number R01 AG023397-02
from the National Institute on Aging; Transdisciplinary Tobacco Use Research Center grant (number P50 CA084719) from the National
Institutes of Health; the Robert Wood Johnson Foundation; and the National Science Foundation (grant number YR4-CCRP1) to
the National Consortium on Violence Research. Dr Koenen is supported by grants K08 MH070627 and MH078928 from the National
Institute of Mental Health.

Competing interests None.

Patient consent Obtained.

Ethics approval This study was conducted with the approval of Brown University and Harvard University.